Differences in Head Size and Shape During the Growth of Deutero Malay Children

Padjadjaran Journal of Dentistry. 2019; 31(1): 53-59.

Differences in head size and shape during the growth of Deutero Malay children

Ameta Primasari1*, Veronica Angelia1, Dimas Agara1

1Department of Oral Biology, Faculty of Dentistry University of North Sumatera, Indonesia

ABSTRACT

Introduction: The growth periods of 0-18 years old can be studied with anthropometry by identifying the head size and shape of the human head. Study on vertical, transverse, and horizontal cephalic indexes can understand differences and growth between sexes and age groups. This study was aimed to analyse the averages and differences in the head size and shape of Deutero Malay children in different age groups. Methods: This research was a descriptive analytic study with cross-sectional design. The sample of 192 Deutero Malay children consisted of boys and girls with an age range of 7-18 years old. Measurement of head height, length, and width was performed to calculate the differences of vertical, transverse, and horizontal cephalic index values by sex and age group, and the classification of the head shape based on the cephalic index values. Results: There was a difference of vertical, transverse, and horizontal by age group, with p = 0.000 (p < 0.05). The average of vertical, transverse, and horizontal cephalic index values was significantly higher in each age group. The average horizontal cephalic index was significantly higher in boys and girls. There was no significant difference in the head shape by the vertical and horizontal cephalic index in all age groups. The highest vertical cephalic index found was chamaecephalic (68%). The highest transverse cephalic index was tapeiocephalic (99%). The highest horizontal cephalic index was hyperbrachycephalic (80%). Conclusion: There is similar head shape of Deutero Malay children, although there may be increasing head size along with age.

Keywords: Deutero Malay, head shape, cephalic index, transverse cephalic index, horizontal cephalic index, vertical cephalic index. p-ISSN 1979-0201, e-ISSN 2549-6212; Available from: http://jurnal.unpad.ac.id/pjd/article/view/17950 DOI: 10.24198/pjd.vol31no1.17950 Submission: Jul 24, 2018; Accepted: Feb 28, 2019; Published online: Mar 29, 2019

way to measure and make observations the form INTRODUCTION of skeletal bones and organs of the human body with specific methods and tools. Anthropology Anthropometry is a branch of the science of is also used in following postnatal growth physical anthropology that studies measurement and development, detecting abnormalities, techniques of the human body that includes a and predicting future growth in adult. Dental

*Corresponding author: Ameta Primasari, Department of Oral Biology, Faculty of Dentistry North Sumatra University, Indonesia. Jalan Universitas No. 30, Medan, North Sumatra, Indonesia 20222. Phone: +62818207891; Email: ameta. [email protected]

53 Differences in head size and shape during the growth of Deutero Malay children( Primasari et al.) anthropology was popularised by Brothwel high hypsicephalic; based on transverse cephalic whose study was focusing on the neck and head, index: tapeiocephalix, metriocephalic or especially the teeth (cranio-dento-facial).1 acrocephalix; based on horizontal cephalic index: Anthropometry is usually more likely to focus dolicocephalic, mesocephalic, brachycephalic or on the dimensions of the dead human body for hyperbrachycephalic. The cephalic index is also identification or attempting to change its original an important parameter in evaluating race and identity.2 The science of anthropometry develops gender differences.9 mainly in the context of anthropology that studies Race is an important concept for studying the classification and identification of racial human variations because humans differ from one and gender differences, the effects of diet and another.10 Indonesia is a multiracial and multiethnic environmental conditions on growth.3 The word nation. The Indonesian originally came from the anthropometry is derived from the Greek word Mongoloid and Australomelanesid races. The ‘anthropos’ means human, and ‘metrein’ means fusion between Mongoloid and Austromelanesid to measure.4 produced Proto Malay and Deutero Malay race.1,11 Head anthropometry measurements can Deutero Malay or known as young Malay came from be used in conjunction with cephalometry, the Yunan region (South China) around 500 BC. Computerized Tomography Scan (CT Scan) Deutero Malay has a more advanced civilization and Magnetic Resonance Imaging (MRI) in the compared to Proto Malay. The ethnic groups in preparation of plastic surgery and reconstructive Indonesia which are included in the Deutero Malay surgery patients.5 One of the most important are Aceh, Minangkabau, Javanese, Sundanese, anthropometric branches is the craniometry Malay, Betawi, Manado, Bali, Madura. Most of the used in orthodontics and cephalometry whose population of Sumatera Utara is Deutero Malay.1 calculations use cephalic index. The cephalic Many studies of head shape are associated index was introduced by Anders Retzius, an with race and sex using horizontal cephalic index Swedish anatomist with the purpose to classify and various head forms are conducted.3 Based populations.1 Cephalic index (CI) and head shape on the results of the study showed that some are greatly affected by geograpical, sex, age, and differences based on the result of cephalic index racial factors. CI can be used as marker of ethnicity.6 and some equations based on head size and shape CI is commonly used to describe individuals’ on three ethnic groups in Nigeria.9 Different ethnic appearances and for estimating the age of fetuses groups tend to have different skull and jawbone for legal and obstetrical reasons. CI can be used size even though they are often influenced by widely in various forensic investigations.7 individual variation.12 Based on the results of a Morphological changes and growth in each study conducted by Ligha, there was a difference individual occur at 8-17 years old. After that age in the cephalic index results between boys and morphological changes and growth do not occur girls aged 7-10 years old and 11-14 years old.13 again. Head growth patterns vary widely by age This result suggested that there were variations and sex, and stops at age 18-20 years old.8 After in the cephalic index or head shape by age group birth, the head grows faster than other part of between sexes.13 the body so the head becomes very dominant. Based on the description above, study on Differences in the growth of the upper and lower differences of head size and shape in the age group head components are important in determining of 7-18 years old by using vertical, transverse, and the type of head, the shape of the dental arch horizontal cephalic index to determine differences and first incisor.1 between age group and to determine the average Measurement of human head shape size of Deutero Malay head can be conducted can use cephalic index method. The cephalic because there is no data about it yet. It will be an index is a measure the ratio (in percent) of interesting study object regarding differences in the maximum length, height and width of the the head size between growing period age groups. skull bone.1,9 Head shape based on vertical This study was aimed to analyse the averages and cephalic index: chamaecephalic, orthocephalic, differences in the head size and shape of Deutero lowhypsicephalic, moderate hypsicephalic or Malay children in different age groups.

54 Padjadjaran Journal of Dentistry. 2019; 31(1): 53-59.

METHODS

The study was conducted at Namira School Jalan Pasar 1 Kelurahan Tanjung Sari Medan, Sumatera Utara. The study was conducted after obtaining approval from the Ethics Commission of the Faculty of Medicine, Universitas Sumatera Utara, and informed consent was obtained from the parent/ guardian of the subject. The type of study was Figure 1. Measurement of head length from glabella to descriptive analytic with cross sectional design. inion using curved caliper.14 The population of this study were student of primary school, junior high school, and senior high school 7-18 years old in Namira School. The sampling method was purposive sampling that subject was selected based on inclusion and exclusion until reaching the amount of sample determined. Minimal sample was needed 186 subject, to make it easy, the amount of sample was based on age grouping, the sample used was 192 people with a division of 48 people 7-9 years old (24 boy and 24 girl), 48 people 10-12 years old Figure 2. Measurement of head height from nation to (24 boy and 24 girl), 13-15 years 48 people (24 boy gnation using digital caliper.14 and 24 girl), and 48 people 16-18 years old (24 boy and 24 girl). Inclusion criteria were 7-18 years The head width was measured the distance old, Deutero Malay (up 2 generation) and normal between parietal eminence or eurion to eurion head shape. Exclusion criteria were undergone (eu-eu). Eurion is the most lateral point of the orthodontic treatment, maxillofacial surgery, cranium, by placing a ruler on the parietal region craniofacial malformation and history/signs of of the head (above the ear) perpendicularly and craniofacial syndromes. Measurement tools used then the ends of the curved caliper are placed on in the study were curved calipers, digital calipers, both the left and right eurion points. The distance and rulers. of both ends of the curved caliper was measured All subjects were asked to sit in a chair with using a ruler and the size was recorded as the an upright position, lean the body in perpendicular maximum head width. position. The head length was measured from the glabella (g) to the inion. The maximum length of the head was measured by placing the tip of the caliper at the point of the glabella and the inion. The distance of the two ends of the calipers was measured using a ruler, and the size was recorded as the maximum length of the head. The head height is measured from the nasion (na) to gnation (gn). The nasion is the point on the nasofrontal suture in the medio-saginal plane Figure 3. Measurement of the head width of eurion-eurion whereas gnation is the point on the underside of using curved caliper.14 the lower mandible of the medio-sagittal. The head height was measured by placing the tip Data recording was the length, height and of the digital caliper at the nasion and gnation width of the head on the subject questionnaire. points. The distance of the two ends of the caliper The following cranial indices were calculated was measured using a digital caliper and the size using the above measurements: Vertical cephalic was recorded as the width of the head.

55 Differences in head size and shape during the growth of Deutero Malay children( Primasari et al.) index = Head height (nation to gnation) x 100 / (linear line between parietal eminence) x 100 Head length (glabella to inion). / Head length (glabella to inion). According According to the vertical cephalic index to the horizontal cephalic index head shapes head shapes were chamaecephalic (< 57.9), were dolicocephalic (< 74.9), metriocephalic orthocephalic (58.0 - 62.9), low hypsicephalic (75 - 79.9), brachycephalic (80.0 - 84.9), and (63.0 - 67.9), moderate hypsicephalic (68 - hyperbrachycephalic (> 85). 72.9), and high hypsicephalic (73 >).Transverse cephalic index = Head height (nation to gnation) RESULTS x 100 / Head width (linear line between parietal eminence). According to the transverse cephalic In this study, we determined the average index head shapes were tapeiocephalic (< 78.9), difference in vertical, transverse and horizontal metriocephalic (79.0 - 84.9) and acrocephalic cephalic indexes by age group 7-18 years old in (85 >). Horizontal cephalic index = Head width Deutero Malay race in boys and girls.

Table 1. Mean of head height, length and width of 7-18 years old Deutero Malay race between boys and girls by age group Boy (cm) Girl (cm) Age group Head height Head length Head width p-value Head height Head length Head width p-value (years old) ( ± SD) ( ± SD) ( ± SD) ( ± SD) ( ± SD) ( ± SD) 7-9 8.66 ± 0.27 17.01 ± 0.41 14.25 ± 0.11 0.00* 8.82 ± 0.31 16.56 ± 0.65 14.26 ± 0.26 0.00* 10-12 9.80 ± 0.50 16.56 ± 0.65 15.87 ± 1.11 9.71 ± 0.41 17.77 ± 1.02 15.58 ± 0.44 13-15 10.12 ± 0.64 17.85 ± 0.58 15.64 ± 0.55 10.10 ± 0.33 17.65 ± 0.70 15.66 ± 0.61 16-18 10.60 ± 0.48 17.65 ± 0.59 15.47 ± 0.68 10.21 ± 0.43 16.63 ± 0.60 15.23 ± 0.57 *significant (p<0.05)

Based on Table 1, the ANOVA analysis width of 7-18 years old based on age group in boy showed that the mean of head height, length, was significant differences (p < 0.05).

Table 2. Mean of vertical, transverse, horizontal cephalic index of 7-18 years old on Deutero Malay race between boys and girls by age group Boy (cm) Girl (cm) Vertical Transverse Horizontal p-value Vertical Transverse Horizontal p-value Age group cephalic cephalic cephalic cephalic cephalic cephalic (years old) index index index index index index ( ± SD) ( ± SD) ( ± SD) ( ± SD) ( ± SD) ( ± SD) 7-9 50.91 ± 1.86 61.29 ± 2.27 83.66 ± 1.85 0.00* 53.29 ± 2.19 61.87 ± 1.80 86.04 ± 2.36 0.00* 10-12 54.27 ± 2.74 62.16 ± 4.09 87.70 ± 4.68 54.29 ± 3.15 61.70 ± 2.59 87.83 ± 4.85 13-15 56.75 ± 3.59 64.62 ± 3.94 87.58 ± 3.17 57.29 ± 2.82 64.62 ± 3.41 88.79 ± 3.64 16-18 60.04 ± 3.19 68.75 ± 4.95 88.25 ± 3.65 61.41 ± 2.65 67.00 ± 3.36 91.62 ± 3.10 *significant (p<0.05)

Based on Table 2, ANOVA analysis showed After obtaining the vertical, the transverse, that the mean of vertical, transverse, horizontal and the horizontal cephalic index size, the results cephalic index head shape of 7-18 years old based can be classified on the vertical cephalic head on age group in boy was significant differences shape index of each sample based on the age (p < 0.05). ANOVA analysis showed that the mean group of 7-18 years old as presented in Table 3. of vertical, transverse, horizontal cephalic index The highest vertical cephalic index found was the head shape of 7-18 years old based on age group chamaecephalic (68%). The highest transverse in girl was significant differences (p < 0.05). The cephalic index was the tapeiocephalic (99%). mean vertical cephalic index of 7-18 years old in The highest horizontal cephalic index was the this study, boy was smaller than girl. hyperbrachycephalic (80%).

56 Padjadjaran Journal of Dentistry. 2019; 31(1): 53-59.

Table 3. Distribution of vertical, transverse, and horizontal cephalic index head shape within group 7-18 years old Cephalic index Head shape n (%) Total Vertical Chamaecephalic 130 (68%) Orthocephalic 48 (25%) 192 (100%) Low Hypsicephalic 14 (7%) Transverse Tapeiocephalic 191(99%) Metriocephalic 1 (1%) 192 (100%) Acrocephalic 0 (0%) Horizontal Hyperbrachycephalic 153 (80%) Brachycephalic 36 (19%) 192 (100%) Mesocephalic 3 (1%) Dolicocephalic 0 (0%)

DISCUSSION index of age 3-6 years old (79.06), age 7-10 years old (79.07), age 11-14 years old (80.26) and age In this study, ANOVA analysis showed that the mean 15-18 years old (80.54).13 Postnatal growth in of head height, length, width of 7-18 years old based spheno-occipital synchondrosis is a major factor on age group in boy was significant differences (p of contributing to cranial base growth and also is a < 0.05) and so did in girl. Nutritional status (diet), guide rail for development of the maxilla, midface economy, habits and living environment are the and mandible, which persists until adult.15 Spheno- factors that influence growth and morphological occipital synchondrosis is the last syncope of the changes of the head. Head growth is strongly joint, starting on the cerebral surface of the 12-13 influenced by genetic factors in addition to other years old girls and 14-15 years old boy and perfect factors like environment, nutrition, degree of ossification on the outside surface at 20 years old. physical activity and health and disease. Genetic According to Todd, morphological changes and factors are the basic capital in achieving the end actual growth in each individual occurs between result of the child’s development process, through 8-17 years old and after that age morphological the genetic instruction contained in the fertilized changes and growth do not occur again.8 ovum, can be determined the quality and quantity The mean vertical cephalic index of 7-18 of growth. Characterized by the intensity and years old in this study, boy was smaller than girl. speed of cleavage, the degree of tissue sensitivity The result of this study is different to the result of to stimulation, the age of puberty and the study done by Salve about vertical cephalic index cessation of bone growth.1 The size of the head study at the age of 20-25 years in India where is also affected by genetics, ecology, geography, mean vertical cephalic index in boy (74.08) and race, gender and age. Factors that greatly affect girl (73.03).16 However, the samples used in both head growth are nutritional and environmental studies took an adult sample and there was no factors. The nutritional status (diet) of each growth of the head. sample varies greatly, where diet is an important This present study shows that the size and factor affecting head growth. Environmental length of the Deutero Malay race head is smaller factors also affect head growth, people living in than Indians when measured using a vertical cold climates tend to have round heads than those cephalic index. Identification of gender from living in hot areas.9 cranial can be done with measurement with 80-90% ANOVA analysis also showed that the mean accuracy. Between the bone character on the head of vertical, transverse, horizontal cephalic index that distinguishes boy and girl is cranial capacity, head shape of 7-18 years old based on age group forehead or frontal bone, zygomaticus bone, in boy was significant differences (p < 0.05), and mandible, gonion and chin angle or gnation.17 Boys so did in girl. There is an increasing variation in heads and faces are generally larger than girls. cephalic index in each age group in this study. The cranial capacity in boys is also 10% larger than Study conducted by Ligha on cephalic index on girls. The forehead or frontal bone in the boy is Nigerian children obtained the value of cephalic flat, while the girls are more rounded.17,18 Only the

57 Differences in head size and shape during the growth of Deutero Malay children( Primasari et al.) structure and size can significantly differentiate sample that has the same nutritional status (diet), boy and girl but the cephalic and head shape economy, customs and environment. can not significantly differentiate gender.18 In the Salve study, the largest vertical cephalic CONCLUSION index head shape was hypsychephalic (100%) and the largest transverse cystic head shape was There is similar head shape of Deutero Malay acrocephalic (100%).16 The results were different children, although there may be increasing head from the studies that have been done, possibly size along with age. because of racial differences where the ethnic India is a Caucasian race while ethnic Malay is REFERENCES Mongoloid race or can be caused by other factors such as growth, genetic or environment so that 1. Hamilah DK, Nasution FH, Trenggono BS. need further study. Antropologi untuk mahasiswa kedokteran gigi. In this study, the highest vertical cephalic Jakarta: Universitas Terbuka; 2005. pp. 1-4, index of Deutero Malay children 7-18 years old 6-7, 57-9. is chamaecephalic (68%). The highest transverse 2. Jadav HR, Kariya VB, Kodiyatar BB, Pensi CA. cephalic index of Deutero Malay children 7-18 A Study to Correlate Cephalic Index of Various years old was tapeiocephalic (99%). The highest Caste/Races of Gujerat State. Natl J Integr horizontal cephalic index of Deutero Malay Res Med. 2011; 2(2): 18-22. children 7-18 years old was hyperbrachycephalic 3. Yagain VK, Pai SR, Kalthur SG, Chethan P, (80%). The results were in accordance with the Hemalatha I. Study of Cephalic Index in Indian results on cephalic index study on Malaysian Student. Int J Morphol. 2012; 30(1): 125-9. students, there were found Malay ethnic heads 4. Chong YZ, Leong XJ. Preliminary Findings in the highest horizontal cephalic index were on Anthropometric Data of 19-25 Year Old hyperbrachycephalic (55.6%) while mesocephalic Malaysian University Students. In: Osman (0%) and brachycephalic (44.4%). Generally, the NAA, Abas WABW, Wahab AKA, Ting HN. shape of the head is hyperbrachycephalic (80%). (eds). IFMBE Proceedings. Proceedings of It is appropriate with our study because it belongs “5th Kuala Lumpur International Conference to the same of race (Mongoloid). Mongoloid race on Biomedical Engineering 2011”; 2011 June divided into two, namely, Asian Mongols and 20-23; Kuala Lumpur, Malaysia. Springer: Indians. The Asian Mongoloid consists of Chinese University of Malaya; 2011. subcontinent (composed of Japanese, Taiwanese, 5. Ngeow WC, Aljunid ST. Craniofacial Vietnamese, Chinese) and Malay subtitles Anthropometric Norms of Malaysia Indians. (consisting of Malaysians, Indonesians and Malaysia : Indian J Dent Res. 2009 : 20 (3) : Filipinos). The Mongoloid Indians are made up of 313-4. Indians in America. Mongoloid race has yellow to 6. Seema, verma P. The study of cephalic index brown skin features, straight hair, slight body hair, in north indian population. Int J Morphol 2016; rounded forehead, wide and flat face and narrow 34(2): 660-4. eyes (especially Asian Mongoloid). Mongoloid race 7. Mador E.S, et al. Cephalic index: a fetal has a brakhophyllal head shape with a cephalic gestational age dependent biometric index > 80. Study shows boys and girls in each race parameter. Asian Journal of Medical Sciences show the same head shape but head width, head 1 2010: 45-48. length, and mean of cephalic index for each race 8. Ferguson DJ. Growth of The Face and Dental in girls is higher than boys.19,20 Arches. In Dentistry for The Child and This study had only seen growth by sex Adolescent. McDonald RE. 10th ed., Missouri: and age groups of different people at the present Mosby Inc. 2016: 375-89. time. Therefore, this study still had shortcomings, 9. Maina MB, Mahdi O, Kalayi GD. Study of so it is necessary to do long-term study for further Vertical and Transverse Cephalic Indices in study such as follow the development and growth Three Ethnic Groups of North Eastern Nigerian of a person from birth to adulthood and use a Origin. Trends Appl Sci Res. 2011; 6: 1280-6.

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